A client has an elevated serum bilirubin level. Which assessment action should the nurse include?

• A. Note any changes in urine color or appearance.
• B. Observe the skin for scratch marks due to pruritus.
• C. Check the color of the sclerae.
• D. Monitor blood pressure and heart rate.

Answer: (C)

Elevated bilirubin causes jaundice, a yellow discoloration from bilirubin pigment buildup. The sclerae are the first and most reliable place to look for this yellowing. By inspecting the color of the eyes, you can detect rising bilirubin early, since scleral icterus appears before other tissues show noticeable yellowing and provides a clearer signal than skin color, which can be influenced by lighting or skin tone. While changes in urine color or itching can occur with liver or biliary problems, they are secondary indicators and don’t directly reflect bilirubin status as readily as the scleral examination. Therefore, checking the color of the sclerae is the most appropriate assessment action.